Department File Number : | M199802325 |
Claim Number : | 0569497127GFL |
Date Submitted : | 11/24/1998 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
UNISOURCE INSURANCE COMPANY | Excess | ||||
Insurer FEIN | Professional License Number | ||||
65-0158251 | |||||
Insurer Contact Information | |||||
Type | Entity Name | ||||
Entity | |||||
Street Address | |||||
City | State | Zip | |||
FL | |||||
Phone | Ext | Fax | E-Mail Address | ||
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | RICHARD | D | EVANS | ||
Insurer Type | Street Address of Practice | ||||
Licensed | *NR | ||||
City | State | Zip Code | County | ||
*NR | FL | 32174 | Volusia | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
*NR | $250,000 | *NR | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
0004513 | Surgery - Urological |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | *NR | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
*NR | |||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
12/3/1994 | 1/18/1997 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
*NR | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
*NR | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
*NR | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
4/14/1997 | 0097-30807 CICI | ||||
County Suit Filed in | Date of Final Disposition | ||||
10/16/1998 | |||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $1,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $11,432 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $1,500 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
*NR |
Updates | |
No updates found. |
Does Dr. RICHARD D EVANS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. RICHARD D EVANS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).